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Li Y, Li X, Yang Q. Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review. PLoS One 2023; 18:e0290949. [PMID: 37656677 PMCID: PMC10473540 DOI: 10.1371/journal.pone.0290949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. METHODS Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. RESULTS The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. CONCLUSION Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.
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Affiliation(s)
- Yue Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Xiao Li
- Nursing College of Yunnan University of Traditional Chinese Medicine, Kunming City, Yunnan province, China
| | - Qin Yang
- College of Nursing Dali University, Dali City, Yunnan province, China
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Weis S, Ludwig TA, Bahassan O, Gild P, Vetterlein MW, Fisch M, Dahlem R, Maurer V. Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation. Int Neurourol J 2023; 27:139-145. [PMID: 37401025 PMCID: PMC10325935 DOI: 10.5213/inj.2346030.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/30/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS). METHODS Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed. RESULTS Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months. CONCLUSION Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.
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Affiliation(s)
- Sylvia Weis
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A. Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Omar Bahassan
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Maurer V, Dahlem R, Howaldt M, Riechardt S, Fisch M, Ludwig T, Engel O. Transcroporal Artificial Urinary Sphincter Placement With Closure of Corporal Bodies—A Long-Term Analysis of Functional Outcomes. Front Surg 2022; 9:918011. [PMID: 35722536 PMCID: PMC9198723 DOI: 10.3389/fsurg.2022.918011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives An artificial urinary sphincter (AUS) is the gold standard for postoperative stress urinary incontinence (SUI). The transcorporal AUS (TC) placement constitutes the main salvage option in high-risk patients suffering from SUI with fragile urethras. The literature analyzing long-term outcomes with respect to explantation rates, continence, and erectile function is scarce. Methods and Patients Retrospective data collection was performed in 2011. TC was applied according to a standardized protocol. TC was implanted after bulbar urethroplasty or double-cuff (DC) explantation. After TC placement, the tunica albuginea was closed in order to minimize the risk of postoperative bleedings and erectile dysfunction. Activation was performed 6 weeks postoperatively. Further follow-up (FU) was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were explantation/objective, subjective, and social continence rates. Objective or social continence was defined as the use of 0 pads/day or <2 pads/day, respectively. Thereupon, postoperative bleedings and erectile function were analyzed. Results A total of 39 high-risk patients were available for analysis. The median age was 72 years. In total, 84.6%, 10.3%, and 2.6% had a history of radical prostatectomy, TURP, and radical cystectomy, respectively. In total, 61.5% had a history of radiation therapy of the prostate, 41% had a history of urethral surgery, and 95% had a history of double cuff explantation. The median FU was 27 months. Objective, subjective, and social continence were 54.5%, 69.7%, and 78.8%, respectively. The median pad usage was 1 pad/day [1–2.5]. Only one patient suffered from a postoperative hematoma. In total, 15.4% of the patients were able to have an erection preoperatively, compared to 7.7% after TC placement. The estimated mean explantation-free survival of the TC was 83 months in the Kaplan–Meier analysis. Conclusions TC AUS implantation constitutes a viable salvage approach in high-risk SUI patients with a mean device survival of almost 7 years and high social continence rates of almost 80%. An intraoperative closure of the tunica albuginea after TC placement allows for very low rates of postoperative hematoma and supports postoperative erectile rigidity.
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Affiliation(s)
- Valentin Maurer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
- Correspondence: Valentin Maurer
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marian Howaldt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A. Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Asklepios Medical Center Hamburg-Harburg, Hamburg, Germany
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Zhang L, Xu Y. Impact of Radiation Therapy on Outcomes of Artificial Urinary Sphincter: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:825239. [PMID: 35237650 PMCID: PMC8882597 DOI: 10.3389/fsurg.2022.825239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTo compare incontinence rates and complications in patients receiving artificial urinary sphincter (AUS) with or without radiotherapy (RT).MethodsPubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases were searched for studies comparing outcomes of AUS between patients with and without RT. Search limits were from 1st January 2002 to 15th September 2021.ResultsEighteen studies were included. Meta-analysis revealed statistically significant reduced odds of the absence of incontinence in the RT group (OR: 0.35 95% CI: 0.21, 0.59 I2 = 51% p < 0.0001) as compared to the no-RT group. We also noted statistically significant increased risk of revision surgery in the RT group (OR: 1.74 95% CI: 1.16, 2.60 I2 = 73% p = 0.07). There was increased risk of infections (OR: 2.51 95% CI: 1.00, 6.29 I2 = 46% p = 0.05) and erosions (OR: 2.00 95% CI: 1.15, 3.45 I2 = 21% p = 0.01) in the RT group, but the difference was significant only for erosions. Meta-analysis revealed a statistically significant increased risk of explantation in patients with RT (OR: 3.00 95% CI: 1.16, 7.75 I2 = 68% p = 0.02) but there was no difference in the risk of urethral atrophy (OR: 1.18 95% CI: 0.47, 2.94 I2 = 46% p = 0.72) and mechanical failure (OR: 0.90 95% CI: 0.25, 3.27 I2 = 54% p = 0.87) between the two groups.ConclusionsOur meta-analysis of recent studies indicates that RT significantly reduces the odds of achieving complete continence after AUS placement. History of RT does not increase the risk urethral atrophy or mechanical failure in patients with AUS. However, the risk of revision surgery, erosions and explantations is significantly increased in patients with RT with a non-significant but increased tendency of infections.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: NCT02612389.
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Affiliation(s)
- Li Zhang
- Department of Pelvic Floor Comprehensive Diagnosis and Treatment Center, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China
| | - Yanwen Xu
- Department of Endocrine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China
- *Correspondence: Yanwen Xu
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Khouri RK, Ortiz NM, Dropkin BM, Joice GA, Baumgarten AS, Morey AF, Hudak SJ. Artificial Urinary Sphincter Complications: Risk Factors, Workup, and Clinical Approach. Curr Urol Rep 2021; 22:30. [PMID: 33779844 DOI: 10.1007/s11934-021-01045-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review risk factors for AUS complications and present a systematic approach to their diagnosis and management. RECENT FINDINGS Established risk factors for AUS complications include catheterization, channel TURP, pelvic radiation, urethroplasty, anticoagulation, cardiovascular disease, diabetes mellitus, frailty index, hypertension, low albumin, and low testosterone. We present our algorithm for diagnosis and management of AUS complications. Despite being the gold standard of treatment for men with SUI, major and minor complications can occur at any point after AUS insertion. Careful consideration of the urologic, medical, and operative risk factors for each patient can help prevent complications. A systematic approach to early and late complications facilitates their identification and effective management. The evaluating urologist must have a thorough understanding of potential AUS complications in order to restore quality of life in men with bothersome SUI.
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Affiliation(s)
- Roger K Khouri
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Nicolas M Ortiz
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin M Dropkin
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Gregory A Joice
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Adam S Baumgarten
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Steven J Hudak
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Terlecki RP, Wilson SK. A new paradigm for surgical revision of the artificial urinary sphincter for recurrent stress urinary incontinence: Wilson’s Workshop 11. Int J Impot Res 2020; 34:37-43. [DOI: 10.1038/s41443-020-0307-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 01/18/2023]
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Abstract
The combination of a severe urethral sphincter defect with simultaneous development of recurrent bladder outlet obstruction characterizes a "devastated bladder outlet", which often is not surgically reconstructable. Clinically, quality of life is considerably compromised in affected patients with a wide variance of symptoms, mostly complete incontinence, but also urinary retention. This condition is usually preceded by multiple endoscopic interventions or even open surgical procedures, occasionally also in combination with radiotherapy of the pelvic region as part of multimodal oncological therapy. Treatment of these cases is complex and limited to few promising procedures. A potential therapy should primarily include the decision about the possibility of preserving the urinary bladder. In individual cases, this can result in simple therapy options while at the same time maintaining an acceptable quality of life for those affected. If there is no possibility of a refunctionalization of the original bladder, supravesical urinary diversion is indicated as a last-resort therapy. This paper provides a review as well as the limits and possibilities of conservative and surgical treatment options for a devastated bladder outlet.
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Affiliation(s)
- A Kocot
- Klinik und Poliklinik für Urologie und Kinderurologie, Julius Maximilians Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
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